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The Kentucky Department for Public Health published proposed changes to the to the swimming pool and bathing facilities regulation in October of 2011. Hydrologic posted the announcement and CH’s response.

Lexington, KY – One of the greatest pleasures people enjoy is a cool dip in the pool. Swimming pools and aquatic venues let people escape the summer’s heat, giving families a chance to enjoy the outdoors. Children choose swimming over any other recreational activity. And swimming is one of the healthiest forms of aerobic exercise.

But are pools safe? The U.S. Centers for Disease Control and Prevention (CDC) cites that close to 14,000 people a year come down with a waterborne disease contracted at an aquatic venue. Of these cases, 96.5 percent were associated with disinfected water venues (pools, spray fountains, water parks) instead of non-filtered river or lake water.

The Northern Kentucky/Cincinnati area suffered from one of the largest Cryptosporidium outbreaks of 2011 — over 250 confirmed cases. Health officials also confirmed roughly 130 cases of Shigella during this time. The outbreak led to more than a dozen pools being treated by superchlorination to stop the spread of illness.

The CDC even has recorded deaths from people being exposed to diseases at aquatic venues. E-coli 0157:H7 killed a young child at a water park in Atlanta. Thousands become ill from diseases contracted at swimming pools, spas, splash pads and water parks. The five primary waterborne diseases — giardiasis, cryptosporidiosis, Legionnaires’ disease, swimmers’ ear, and mycobacterial infection—all are found at aquatic venues. Outbreaks from these diseases lead to over 40,000 hospitalizations annually, costing $970 million per year. Almost half that amount, $430 million, was paid by taxpayers through government-funded Medicaid and Medicare patients.

Some data suggests the chemicals used to rid indoor and outdoor pools and aquatic facilities of bacteria and other disease-causing germs, mainly chlorine and bromine, may react with contaminants in water to produce by-products that may in turn increase the risk for cancer and asthma. The exact negative health consequences that long-term exposure to disinfection byproducts cause is not established. However, minimizing risk to potentially harmful chemicals is important. As a result, indoor air quality and ventilation practices and standards at indoor aquatic facilities continue to evolve. Improper operation and maintenance at pools can create chemical vapors that patrons breathe. Poor design of indoor aquatic facilities locks air inside and does not allow for proper fresh air exchange to remove these noxious vapors. Eyes, ears, lungs and skin can become infected from improperly treated pool water.

Drowning, chemical exposure, suction entrapments and waterborne illness all are major public health risks associated with aquatic venues. Drowning is the leading cause of injury death for young children between the ages of one and four, and the second leading cause of unintentional injury death for all children age one to 14. Chemicals in pools led to 4,574 emergency room visits by pool patrons in 2008. Waterborne diseases from pools and spas harmed 13,966 swimming patrons in 2008.

All of these health threats, however, are preventable.

Properly maintained aquatic venues operated by professional, well-trained staff cause fewer cases of illness, injuries or outbreaks of waterborne diseases, according to CDC studies. Studies of outbreaks at aquatic venues show that disinfectant levels and other water-quality parameters often are not maintained. Pools that follow standards regarding pathogens in feces or vomit released into pools and have standards regarding young children in diapers have less chance of causing waterborne outbreaks.

Kentucky’s pool code

Kentucky’s pool code, last revised in 1996, does not address many of these aquatic health threats. The code does not require operators trained in public health safety and disease prevention. Even splash pads and spray fountains are not covered. By being out-of-date, the pool code allows aquatic venues to operate without health protections, exposing their patrons to waterborne threats.

Many splash pads in this state have not been designed to industry standards and are not required to be operated by people properly trained. Interactive water features in Kentucky have been built without disinfectants or adequate filtration capacity. Contaminated water can look just like any other water when it’s sprayed up through the air.

By relying on an outdated code, Kentucky jeopardizes its citizens by making water recreation less safe. The operation and maintenance of pools and spas are following codes written 16 years ago. Health threats unknown in 1996 are not addressed in the current pool code.

Aquatic venues are not regulated by the federal government. State and local governments are responsible for adopting pool codes. No single law regulates these venues (and therefore, no uniform national standard exists).

Public swimming pools and spas are forced to meet an inconsistent variety of health and safety standards, depending on location and activity. A municipal pool located in Louisville will be subject to city and county operation and maintenance requirements, whereas a similar pool in Lexington is not, instead relying on Kentucky state code. A public venue privately owned may be exempt from local regulations, but is subject to industry standards mandated by their parent corporation. The response to recreational waterborne disease varies significantly among the state and local agencies.

The Model Aquatic Health Code

The Model Aquatic Health Code (MAHC) serves as a tool for local and state public health agencies needing to adopt or revise laws regarding public aquatic venues and pool safety. The MAHC is divided into a series of 14 different modules, each designed independently, which together create a comprehensive tool to review and update state or local public health swimming pool regulations.

The MAHC is a result of a collaborative effort between the CDC and experts on recreational water health and safety, including members from the federal government, state and local health departments, manufacturers, academia and nonprofit aquatic associations. Each of these organizations participated to develop the MAHC, recognizing the need for a national public health standard for aquatic venues. The intent of this health-based scientific code is to reduce illnesses, drowning, injuries and waterborne disease outbreaks at recreational water venues.

Kentucky has an opportunity to update their codes with the latest scientific expertise on aquatic venue health and safety. By expanding the code to cover splash pads, by revising the code to combat waterborne illness and by updating the code to reflect modern operating procedures, Kentucky will protect the swimming public from these harms, ensuring they enjoy the benefits of swimming for years to come.

Tracynda Davis is the director of environmental health programs at the National Swimming Pool Foundation.